Phase III trial evaluating the addition of bevacizumab to endocrine therapy as first-line treatment for advanced breast cancer: the letrozole/fulvestrant and avastin (LEA) study

Miguel Martín, Sibylle Loibl, Gunter von Minckwitz, Serafín Morales, Noelia Martinez, Angel Guerrero, Antonio Anton, Bahriye Aktas, Winfried Schoenegg, Montserrat Muñoz, José Ángel Garcia-Saenz, Miguel Gil, Manuel Ramos, Mireia Margeli, Eva Carrasco, Cornelia Liedtke, Grischa Wachsmann, Keyur Mehta, Juan R De la Haba-Rodriguez

Research output: Contribution to journalArticleResearchpeer-review


PURPOSE: To test whether combining bevacizumab, an anti-vascular endothelial growth factor treatment, with endocrine therapy (ET) could potentially delay the emergence of resistance to ET.

PATIENTS AND METHODS: A multicenter, randomized, open-label, phase III, binational (Spain and Germany) study added bevacizumab (15 mg/kg every 3 weeks) to ET (ET-B; letrozole or fulvestrant) as first-line therapy in postmenopausal patients with human epidermal growth factor receptor 2 (HER2) -negative and hormone receptor-positive advanced breast cancer. We compared progression-free survival (PFS), overall survival (OS), overall response rate (ORR), response duration (RD), time to treatment failure (TTF), clinical benefit rate (CBR), and safety.

RESULTS: From 380 patients recruited (2007 to 2011), 374 were analyzed by intent to-treat (184 patients on ET and 190 patients on ET-B). Median age was 65 years, 270 patients (72%) had Eastern Cooperative Oncology Group performance status of 0, 178 patients (48%) had visceral metastases, and 171 patients (46%) and 195 patients (52%) had received prior chemotherapy or ET, respectively. Median PFS was 14.4 months in the ET arm and 19.3 months in the ET-B arm (hazard ratio, 0.83; 95% CI, 0.65 to 1.06; P = .126). ORR, CBR, and RD with ET versus ET-B were 22% versus 41% (P < .001), 67% versus 77% (P = .041), and 13.3 months versus 17.6 months (P = .434), respectively. TTF and OS were comparable in both arms. Grade 3 to 4 hypertension, aminotransferase elevation, and proteinuria were significantly higher in the ET-B arm. Eight patients (4.2%) receiving ET-B died during study or within 30 days of end of treatment.

CONCLUSION: The addition of bevacizumab to ET in first-line treatment failed to produce a statistically significant increase in PFS or OS in women with HER2-negative/hormone receptor-positive advanced breast cancer.

Original languageEnglish
Pages (from-to)1045-52
Number of pages8
JournalJournal of Clinical Oncology
Issue number9
Publication statusPublished - 20 Mar 2015


  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Humanized/administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols/therapeutic use
  • Bevacizumab
  • Breast Neoplasms/drug therapy
  • Disease-Free Survival
  • Drug Resistance, Neoplasm
  • Estradiol/adverse effects
  • Female
  • Fulvestrant
  • Germany
  • Hormones/administration & dosage
  • Humans
  • Letrozole
  • Middle Aged
  • Nitriles/administration & dosage
  • Postmenopause
  • Spain
  • Treatment Outcome
  • Triazoles/administration & dosage
  • Vascular Endothelial Growth Factor A/antagonists & inhibitors


Dive into the research topics of 'Phase III trial evaluating the addition of bevacizumab to endocrine therapy as first-line treatment for advanced breast cancer: the letrozole/fulvestrant and avastin (LEA) study'. Together they form a unique fingerprint.

Cite this